Use of older controlled non-heart-beating donors for liver transplantation

Background. Use of liver grafts from non-heartbeating donors (NHBDs) warrants consideration so to expand the donor pool. Because the results of controlled NHBDs (CNHBDs) were acceptable, we have recently tried to expand the criteria to older CNHBDs. Here, we report our experience using liver grafts from older CNHBDs. Methods. We retrospectively studied our donor records from June 1994 through December 2001. CNHBDs were divided into two groups by age: older donors (O) were more than or equal to 55 years old, and younger donors (Y) were less than 55 years old. We compared donor and recipient demographics and peak laboratory values during the first postoperative week. Results. Twenty-five grafts from CNHBDs were transplanted in our center. Five livers were harvested from O (63±6 years) and 20 were from Y (32±15 years). No differences other than age in donor characteristics were noted between O and Y. Mean age of recipients was 50 years in both groups. Mean cold ischemic time (CIT) was 5.4 hours in O and 7.3 hours in Y (P<.05). Peak glutamic oxaloacetic transaminase (U/L), glutamic pyruvic transaminase (U/L), bilirubin (mg/dL), and prothrombin time (sec) during the first postoperative week were 611, 500, 3.9, and 16 in O and 846, 593, 5.9, and 17 in Y. There were no significant differences between the two groups. The graft survival at 1 year was 80% in O and 70% in Y. Conclusions. In our preliminary experience, recipients of liver grafts from older CNHBDs had an outcome equivalent to that of younger CNHBDs. With the strict evaluation of the donors and brief CIT, liver grafts from older CNHBDs may be used to expand the donor pool.